Extended Spectrum ß-lactamase (ESBL) Producing Multi Drug Resistant (MDR) Urinary Pathogens in a Children Hospital from Nepal.

Background Multidrug resistant in clinical bacterial isolates has increasingly been reported through out the world and is associated with high morbidity, mortality and increased health care costs. It is important to determine the status of multidrug resistance pattern to understand the current resistance trend so that appropriate antibiotics can be used in practice. Objective To determine the antibiotic resistant profile and prevalence of extended spectrum ß-lactamase producing multidrug resistant strains in pediatric patients of Kanti Children's Hospital, Kathmandu, Nepal. Method Urine sample was cultured by standard microbiological techniques and bacterial isolates were identified using different biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method and extended spectrum ß-lactamase detection was carried out using combined disc method as recommended by Clinical Laboratory Standard Institute guidelines. Result All together 65 different bacteria were isolated and subsequently identified. E. coli was the most common isolate with 46 (71%) isolates 63% of these isolates were multidrug resistant. Gram negative isolates were most resistant to nalidixic acid (81.97%) followed by ampicillin (69.35%) and co-trimoxazole (69.35%). The extended spectrum ß-lactamase producing isolates were 43% among total isolates. Conclusion Higher rate of Extended Spectrum ß-lactamase production among multidrug resistant isolates suggested routine extended spectrum ß-lactamase testing in clinical isolates.

Utilisation of waste medicine wrappers as an efficient low-cost electrode material for microbial fuel cell.

Waste generation from healthcare facilities now has become a concerning issue as it contain plastic and metals. Medicine wrappers are one of the major portions of healthcare solid waste, which impel intensive solid waste management practice due to fewer possibilities of deriving by-products. However, it can be recycled and used as an electrode material in microbial fuel cells (MFCs). An electrode material for application in MFCs is a crucial component, which governs total fabrication cost as well as power recovery, thus a cost-effective, stable and durable electrode is essential. In this endeavour, a new metallic (aluminium) waste material, a waste medicine wrapper (WMW), was evaluated for feasibility to be used as anode/cathode in MFCs. Based on the stability test under corrosive environment (1 N KCl), the WMW electrode sustained a maximum current of 46 mA during cyclic voltammetry (CV) and noted only 14% reduction in current at an applied voltage of +0.4 V after 2500 s in chronoamperometry, indicating its good stability. Power recovery from MFC using WMW was higher than the MFC using bare carbon felt as an anode (27 vs. 21 mW/m2). The entire analytical test results viz. CV, electrochemical impedance spectroscopy and power performance established WMW as an excellent anode rather than cathode material.

Seroprevalence of anti HCV antibodies among blood donors in Kathmandu valley, Nepal.

AIMS AND OBJECTIVES: To study the seroprevalence of anti HCV antibodies among Nepalese blood donors in relation to their age, sex, type of donation and times of donation. MATERIALS AND METHODS: Descriptive cross-sectional study conducted in Nepal Red Cross Society (NRCS), Central Blood Transfusion Service (CBTS), Kathmandu, from December 1, 2006 to September 1, 2007. A total of 33,255 blood donors were screened for anti HCV antibodies by ELISA. Donor's information was collected from blood donor's record form and statistical analysis was done using the software 'SPSS 11.5' and 'Winpepi ver. 3.8'. RESULT: The seroprevalence of anti HCV antibodies in blood donors was 0.66% (95% CI= 0.58-0.76). Higher seroprevalence was observed in male donors (0.7%, 95% CI= 0.6-0.8) than in female donors (0.4%, 95% CI= 0.2-0.6) (P < 0.05). The seroprevalence was highest (0.82%) in the age group of 21-30 years and there was significantly decreasing trends in seroprevalence with increasing age (P < 0.05). The highest seroprevalence among the male donors (0.88%) was also observed in the age group of 21-30 years (P < 0.001). Among female donors the seroprevalence (0.47 %) was highest in age group 41-50 years (P > 0.05). The seroprevalence of anti HCV was significantly higher in volunteer donors (0.7%) than in replacement donors (0.4%) (P < 0.05). Similar seroprevalence of anti HCV was observed in first time (0.65%) and repeat blood donors (0.67%) (P > 0.05). CONCLUSION: The seroprevalence of anti HCV antibodies among blood donors in this study was similar to the seroprevalence reported for general population by other studies. Similar seroprevalence in first time and repeat blood donors as well as higher seroprevalence in volunteer donors than in replacement donors are the potential threats to safe blood supply, which urges the need of more effective donor education and counselling of blood donors.

Status of pathology professionals.

BACKGROUND: The status of basic, general and specialist workforces in pathology services in Nepal needs to be defined and explored for better pathology services. The objective of the study was to find out the status of laboratory medicine professionals (pathology workforces) and the regulation of ethics and limitations of the different level of workforces. METHODS: A cross-sectional descriptive study was conducted by observing and taking interview with the head of the clinical private institutions from August 2008 to January 2009. A total of 373 private pathology laboratories and the workforces working over there were included in the study. RESULTS: The workforces heading private pathology services showed that 153 (41%) of laboratories were headed by laboratory assistant, 79 (21%) by laboratory technician, 90 (24%) by (medical technologist) pathology officer, 30 (8%) by histocytopathologist and 21 (6%) by non pathology professionals. Officer level Pathology workforce (eligible to work independently) was 113 (30%) whereas 260 (70%) of laboratories had no such workforces. Intermediate level Pathology workforce (eligible to work dependently and for some investigation independently) was 34% (127/373) where as 66% (246/373) of laboratories were lacking such workforces. Specialist level (MD/M. Sc) workforces in histocytopathology, clinical microbiology and cytopatholgy & hematology were 43 (11%), 10 (3%) and 3 (1%) respectively. CONCLUSIONS: The workforces heading the private laboratories were not according to the norms of good laboratory practices. The workforces had crossed their limitations and ethical barrier in performing pathological investigations which did not abide by the rules and regulations made by respective councils of Nepal by pathology workforces. There was intervention of non medical/clinical workforce in laboratory services especially in microbiology and biochemistry.

Seroprevalence of HBV and HCV in blood donors: A study from regional blood transfusion services of Nepal.

BACKGROUND AND OBJECTIVE: Hepatitis B and hepatitis C are significant health problems that might involve the late sequel of liver cirrhosis and hepatocellular carcinoma. A high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in blood donors poses an increased risk of window period transmission through blood transfusion. The present study aimed to know the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors in regional blood transfusion services of Nepal. MATERIALS AND METHODS: This was a retrospective study conducted among blood donors in Banke (5,211), Morang (5,351), and Kaski (5,995) blood transfusion services. Serum samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies using rapid enzyme immunoassays. The donors information was collected via the donor record register through their respective blood transfusion services. The software "Winpepi ver 3.8" was used for statistical analysis. RESULTS: The seroprevalence rate of HBV was highest in the Banke (1.2%) followed by Biratnagar (0.87%) and Kaski (0.35%) (P < 0.0001). The seroprevalence of HCV was highest in the Morang (0.26%) followed by Kaski (0.16%) and Banke (0.11%) (P > 0.05). The seroprevalence of HBV was significantly higher than HCV in all three blood transfusion services. The burden of HBV as well as HCV seems to be higher in male donors (P > 0.05). CONCLUSION: The study revealed that the seroprevalence of HBV was alarmingly higher in two of the three blood transfusion services. Implementation of community-based preventive measures and improved strategies for safe blood supply might prove useful to decrease the seroprevalence.

Study on CD4 cell responses in HIV infected subjects in Nepal.

HIV infection is characterized by gradual deterioration of immune function mainly the CD4 cells. This study was conducted with the objectives to evaluate the kinetics of CD4 cell depletion and duration of HIV infection and the role of ART in improving CD4 cell levels specifically in Nepalese HIV patients. During April 2005 to March 2006, all together 220 blood samples collected from 110 HIV patients visiting National Public Health Laboratory (NPHL), Kathmandu, were analyzed for CD4 cell count using standard protocol. CD4 cell count before and after starting of anti-retro viral therapy showed significant association (P<0.05). The results of this study clearly indicated that antiretroviral therapy has been playing a role in maintenance CD4 cell counts in HIV infected patients.

Prevalence of acute diarrhoea in Kathmandu valley.

This retrospective study was conducted during January to September in the year 1997. Three hundred and forty nine stool samples were collected from diarrhoea patients from different places of Kathmandu valley and examined at National Public Health Laboratory (NPHL), Teku, Kathmandu. Acute diarrhoea becomes epidemic in rainy season and is a major public health problem of the city. In this study, people with poor hygiene practice and poor education were infected more than other people. Among the 349 patients with the gastrointestinal disease, 26.0% were found to have bacterial infection. Out of which, 88 (25.1%), one (0.28%), one (0.28%), and one (0.28%) were found to be Vibrio cholerae 01, Vibrio cholerae 0139, Shigella dysenteriae and Escherichia coli respectively. Cholera cases were found almost throughout the year in the city though the numbers increased during the rainy season. It was highest during July (34.6%) followed by August (32.35%), September 32% and June (6.89%). The uncommon species of Vibrio i.e. Vibrio cholerae 0139 was also found in the study. Higher prevalence was found in urban areas (83.52%) than in rural areas (16.48%). Antimicrobial susceptibility testing of bacterial isolates showed that Ciprofloxacin (97.85%) was found to be the most effective antibiotic followed by Tetracycline (92.34%), Erythromycin (92.34%), Norfloxacin (93.34%), Cholramphenicol, Ampicillim, but Cotrimoxazole were found to be resistant to all isolated Vibrio cholerae.